Background: Optimizing attendance rates in outpatients clinics is important to ensure good clinical care and to avoid waste of scarce medical resources. In 2016, we identified a cohort of 17 teenagers that frequently Do Not Attend (DNA) the Paediatric Diabetes Multidisciplinary Clinics, compromising patient care and reducing compliance with NICE and BPT standards. As this cohort was found to be enrolled in a cluster of 5 schools we explored the benefit of taking diabetes clinics into school.
Objectives: Design and deliver additional school-based clinics to increase patient contact. Measure the effect of the intervention on HbA1c and other patient related outcomes, hospital resources, attendance and adherence to standards.
Patients and methods: Between January and June 2017, quarterly school-based clinics were offered to all teenagers with T1DM in these 5 schools. A semi-structured interview was administered to identify their concerns about diabetes. Patients were invited to provide feedback about hospital clinics. HbA1c was checked and glucose meters downloaded. Outcome data was compared with previous 9 months. Families were informed by letter, allowing them to opt-out. 34 teenagers were targeted (17 initially identified as frequent non-attenders and 17 controls at same schools). 50% had pre-intervention HbA1c > 75 mmol/mol.
Results: The hospital DNA rate was reduced in the intervention group by 50%. School-based clinics improved clinical contacts, providing opportunities to empower teenagers and to re-engage with patients that were difficult to reach pre-intervention. Gaps in patients knowledge and psychosocial/lifestyle concerns not previously appreciated by the diabetes team were identified in 50% of the patients. These issues were addressed on an individual basis, involving parents, relevant diabetes healthcare professionals and schools nurses/carers. Negative feedback included anxiety about results, waiting times and parental or healthcare professionals judgemental attitudes. HbA1c levels remained unchanged over the study period. Five patients in the control group who were at imminent risk of reaching HbA1c levels > 75 mmol/mol, managed to stabilise their glycaemic control during the intervention.
(i) This pilot shows promise in improving contact in this difficult to reach group while reducing wasted hospital clinic slots.
(ii) School clinics are an effective way to engage young people in self-management, actively preparing them for transition.
(iii) A well powered trial may allow HbA1c improvement to be shown.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes